Treating Ebola patients: a ‘bottom up’ approach using generic statins and angiotensin receptor blockers

• Ebola virus disease in West Africa has a high mortality rate.
• The loss of endothelial barrier integrity causes massive fluid losses.
• Atorvastatin and irbesartan reduced Ebola mortality in Sierra Leone.
• Treatment is safe and restores endothelial barrier integrity.
• This inexpensive generic treatment is widely available in West Africa.

SummaryThe international community has responded to the Ebola outbreak in West Africa with a ‘top down’ approach. This has contributed to outbreak control, but has done much less to reduce the high mortality rate in individual patients. Ebola patients experience a breakdown in endothelial barrier integrity that leads to massive fluid losses and vascular collapse. Statins and angiotensin receptor blockers (ARBs) maintain or restore endothelial barrier integrity. Local physicians in Sierra Leone have treated approximately 100 consecutive Ebola patients with atorvastatin and irbesartan, and all but two inadequately treated patients have survived. The results of this experience have not been released and they need to be reviewed and validated. Unlike other treatments that target the Ebola virus itself, this ‘bottom up’ approach to treatment represents a paradigm shift by targeting the host response to infection. Treatment with these safe, inexpensive generic agents could be implemented readily throughout West Africa.